Should Women Take Creatine?

By Cassandra Forsythe, PhD, RD

If you’ve been around the gym environment long enough, the subject of creatine has probably come up. You've seen someone at the gym having a pre-workout drink and wondered what was in it. You've read about it online or in your favorite fitness magazine. You've overheard conversations between a trainer and trainee, or between training buddies deadlifting next to you.

As someone who's interested in optimizing her workouts and nutrition to look feel good, and be healthy and strong, you're probably wondering, "What’s up with creatine? Should I be taking it?"

Creatine is well-known for enhancing strength, increasing muscle mass, and improving exercise performance, yet many women who train don’t take it.

Why is that?

Most women think of creatine as a supplement you take only if you want to gain serious muscle or strength. They’ve also heard that creatine causes water retention and weight gain. Let’s face it, most of us might say, “No, thank you!” when we hear that. (Feelings of PMS anyone?)

While some of this is partially true, some is situational. In this article, you will learn everything you need to know about creatine so you can decide if it’s a supplement you want to consider including in your nutrition strategy.

What is creatine? Where does it come from?

The first point that needs to be made is that creatine is not a steroid. In fact, it is a completely different chemical compound that is not at all related to hormones.

Scientists discovered creatine in the early 1800’s. They found that creatine was an important component in the muscles of most mammals and named the discovery after the Greek work for flesh, Kreas.

In particular, they were studying animal physiology and discovered that a wild fox contains 10 times more creatine in its muscles than a fox in captivity. This increase was thought to be a byproduct of the higher exercise level of the wild fox compared to its sedentary counterpart. Future research confirmed these conclusions, and now creatine is one of the most popular sports supplements on the market.

Creatine is produced naturally in your body, primarily the liver, from the precursor amino acids arginine, glycine, and methionine.

Even though creatine is made of amino acids, it’s not considered a protein because it’s metabolized differently. Unlike proteins, when creatine is broken down, it doesn’t involve the removal of nitrogen when excreted from the body by the kidneys.

The concern that creatine may harm your kidneys because of increased nitrogen removal is unwarranted.

Since your body has the ability to produce creatine, it’s technically not considered an essential dietary nutrient, but supplementation does prove useful for those interested in increased strength and muscle growth.

Creatine is also found in small quantities in your diet from some protein foods, primarily red meats (beef, lamb, pork) and fish. The normal dietary intake of creatine in people who eat meat is about 1 gram, and for obvious reasons, intake is much lower in vegetarians.

The supplemental form of creatine manufactured in the laboratory is a tasteless and odorless white powder. The most common type of creatine — and the most researched — is creatine monohydrate. There are other forms of creatine available on the market, such as creatine ethyl ester and serum creatine, which I’ll also talk about in this article.

How does creatine work?

If the scientific details make your head spin, just know that creatine helps your muscles work harder and longer by helping to replenish the fuel (ATP) within muscle cells that allows muscles to sustain energy.

And now, the science.

Creatine allows your muscles to sustain energy by helping to replenish ATP (adenosine tri-phosphate), the energy currency of your muscle cells. In your muscles, creatine combines with a phosphate (Pi) molecule to create a compound called phosphocreatine (PCr). In this new form, PCr plays an integral role in energy metabolism within your muscle cells, especially in activities that require shorts bursts of intense energy, like weightlifting and sprinting.

creatine-alli-squat-450x340Basically, if you want your muscles to contract so you can move or lift a weight, you have to expend ATP. When your muscles contract, ATP is broken down to adenosine di-phosphate (ADP) and a phosphate molecule, with the help of the enzyme ATPase, creating the desired end product: energy to allow your muscles to move.

Within your muscles, there's only a limited supply of ATP. So, if you use all your ATP without replenishing it, your muscles will not be able to continually contract, and you will fatigue quickly.

In order to replenish ATP, you need another Pi molecule, which is primarily supplied from the creatine molecule PCr. The Pi is separated from PCr in the creatine kinase reaction and donated to ADP to reform ATP. This reaction allows you to work harder for a longer period of time, which means you can build more muscle and burn more fat without tiring out too quickly.

The creatine kinase reaction ensures a constant supply of ATP for exercising muscle as long as PCr does not become completely depleted.  However, just like ATP, the natural PCr stores in your muscles are also limited and will decline rapidly once you start doing some serious exercise.

For example, during 10 seconds of an intense cycle exercise test in the lab, peak power is reached during the first 5 seconds and declines as the PCr in the muscle is depleted. As the concentration of PCr decreases, fatigue quickly sets in.

Luckily, in recovery from intense exercise, PCr is resynthesized rapidly. In fact, about 95 percent of PCr is recreated after just three to four minutes. For this reason, a woman lifting a very heavy weight for one to three reps will often need to rest for at least three minutes before repeating her next set successfully.

Now, aren’t you glad you read that?

How does creatine affect women?

Although most creatine research has been conducted in men, some evidence indicates women also benefit from creatine supplementation. Similar to men, women can experience significant muscle creatine accumulation and performance enhancement in response to creatine monohydrate. However, some studies show little to no benefit at all.

Overall, creatine seems to have a beneficial effect on strength in women who take it for a long period of time. However, the available evidence doesn’t show much benefit for women in short-term use (less than 28 days) on anaerobic power, such as sprinting performance or HIIT training7-10.

In one study, researchers examined the effects of creatine supplementation during a 10-week resistance training program in physically active, but untrained, women.  During the 10-week program, all women performed resistance exercises (five sets, 12 repetitions at 70 percent RM for leg press, shoulder press, squat, leg extension, leg curl, and bench press) for one hour three times per week4. A 20-gram/day loading dose of creatine for four days was followed by five grams per day for the remainder of the program.

creatine-molly-deadlift-450x340After the four-day loading regimen, muscle PCr levels increased by 6 percent and the five-gram maintenance dose was adequate to maintain this increase over the duration of the study. When strength was tested at the end of the 10 weeks, women in both groups showed significant improvements in strength in all exercises, which is expected, given that they were all untrained. However, the women taking creatine had a 20–25 percent greater increase in one-rep max (1RM) strength for the leg press, leg extension, and back squat compared to the women taking nothing.

In a similar study, researchers examined the effect of five weeks of creatine monohydrate supplementation using 16 NCAA Division I female lacrosse players during their preseason conditioning program5. Half of the women were given creatine at a loading dose of 20 grams per day for seven days, followed by a maintenance dose of two grams a day for the remaining 24 days. The other women took a placebo. All women completed a resistance training workout three times per week.

The results showed that the women taking creatine demonstrated a significantly greater increase in their maximum bench press strength compared with those taking a placebo. These researchers agreed with the previously mentioned study and suggested that creatine likely provided a greater stimulus for training, which helped enhance strength.

In the final long-term study done to date, researchers examined the effects of creatine in 14 female NCAA Division I soccer players6. Seven women were given creatine, and seven were given a placebo. The women given creatine received 15 grams per day for the first five days followed by five grams per day for the remainder of the study. After 13 weeks, women taking creatine had greater gains in maximal bench press and squat strength than the women taking the placebo.

In 2014, sports nutrition researchers looked at the effects of 28 days of creatine supplementation with or without Beta-alanine on body composition, muscle function, and water retention in 32 active college-aged women15. Over the 28 days, the women participated in their normal activities and were then tested at the end for changes in aerobic and anaerobic performance, muscle creatine content, and body composition. Overall, the results showed that most of the women, even those in the placebo group, had beneficial changes in body composition, including reduced body fat and increased muscle mass. They also had no significant changes in body water.

With respect to exercise results, only the creatine group showed a slight benefit for increased aerobic capacity and increased maximal oxygen consumption, and none of the groups showed a benefits in sprint (anaerobic) exercise performance. Muscle strength was not tested, so nothing could be deduced about this effect. Results may have not been seen either because the muscle creatine contents of the participants’ muscles were not maintained throughout the study. When the investigators discussed this finding, they noted that their scientific methods for muscle creatine measurement had low reliability and could have been flawed, so results may not have been accurate.

Criticism for this study was that the amount of women tested was very small for each group, the length of study was short, and the women were not put into a strength training regimen to determine how these supplements could have influenced a specific program. Overall, these results lend support to the phenomenon of “creatine non-responders” (individuals who do not obtain any benefits from creatine supplementation).

Does creatine work for all women?

With creatine, there are those who benefit from supplementation (responders) and those who do not (non-responders). The lack of effects seen in some studies in women could be due to the fact that these women do not respond to the effects of creatine, in terms of muscular strength, power, or aerobic capacity.

The non-responder phenomenon could be related to the type of muscle fiber and size of cross-sectional area of muscle fibers that a person possesses uniquely. Men and women who have more fast twitch fibers (strength muscle fibers) and a larger initial cross-sectional area of all muscle fiber types can increase their muscle creatine more after seven days than those with fewer fast twitch fibers or smaller muscle cross-sectional area.

From a biological sex perspective, women usually have smaller cross-sectional muscle fiber areas of both their fast twitch and slow twitch fiber types, as do women and men who do more aerobic activity than strength training.

It has also been suggested that women possess a naturally higher average total muscle content of creatine (10 percent) than their male counterparts, so they may need to ingest more in order to increase their creatine levels above their natural levels, which means more than 3 to 5 grams per day (>0.1 g/kg/day) may be necessary. Overall, these physiological differences between men and women may explain why certain women do not respond to the effects of creatine supplementation.

For example, in 2006, researchers showed a lack of benefit from creatine supplementation in trained women11. In this 10-week study, 26 young resistance-trained women were split into two groups. One group was given a placebo, and the other was given creatine at a dose of 0.3 g/kg/d for the first seven days (about 17 grams per day for the average women) and then given a dose of 0.03 grams per kg for the remainder of the study (about 1.7 grams per day). The women trained four days a week and were encouraged to increase the amount of weight they could lift each time they trained.

After 10 weeks, all women improved their strength in bench press and leg press and increased their training volume, but there were no differences between those women who took a placebo and those that took creatine. The authors concluded that in this study, creatine had no effect on strength or performance in trained women, which could have been due to the non-responder effect, or the low dosage of creatine.

Can I become a creatine responder?

The most important ways to increase your chances of being a responder are the following:

Make sure you take enough creatine to increase your muscle creatine content. At least 0.1 grams per kg body weight per day is probably the minimum amount. And, you can load with creatine for the first week of taking it at a dose of 0.3 g/kg/day to quicken the results.

Give creatine enough time to work and be consistent with your intake during this time. One month of use at a typically recommended dose may not be enough. Just as your body usually works in 28-day cycles (hello, menstruation!), give it at least two cycles (about two months) to see if it has any effect.

Take a quick-digesting source of simple carbohydrates with your creatine. Some examples: fruit, juice, yogurt, or other dairy. This will increase blood insulin levels, which causes most substances in your blood to be driven into muscle cells for usage or storage.

Research suggests that insulin can enhance creatine accumulation in muscle only if they are present at extremely high concentrations12. As such, you need more than a few grams of quick-digesting carbohydrate to make a difference.

A good practice is to take creatine with your post-workout shake or meal, which is the perfect time to take in a large dose of carbs. For example, a smoothie with one cup of plain yogurt, a medium banana, and berries will provide about 30 grams of quick, usable carbs. The whey protein found naturally in the yogurt will also naturally raise your insulin levels even further.

Will creatine make me bloated or gain weight?

Many women shy away from creatine because they've heard it comes with water retention, and some of us already experience enough of that during certain times of the month. Interestingly though, the research shows that men tend to experience more water retention than women, with an average increase of body water of 1.5 to 2.0 kg.

You may experience some weight gain with creatine, which is similar to any woman who is new to weight lifting and begins to add more muscle weight. Some women may freak out a little when their weight goes up due to muscle gain, but then feel much better once they see how much more comfortable their clothes fit as they become leaner.

Sometimes women will retain water in the first few weeks of using creatine, but this effects seems to diminish over time. As suggested above, if you start taking creatine, give your body enough time to see results before you decide to stop using it.

How much creatine do I need to take?

The general and scientific recommendation is to take 3 to 5 grams of creatine per day. There's no need for a loading dose of about 20 grams per day unless you want to see results faster. Avoiding loading will lengthen the time it takes for your muscles to become saturated with creatine, but after about one month of the minimal dose, your muscles will be ready.

The recommendation of 3 to 5 grams creatine per day came from the fact that in an average healthy person, approximately 2 grams of creatine is broken down and excreted in the urine per day. Taking at least 3 grams a day ensures that you replace this lost amount and enhance your muscle content of creatine by at least a small amount.

If you want to be more precise with your creatine dose based on your body weight, you can load with 0.3 grams per kilogram body weight (divide pounds by 2.2 to get kg) for 5 to 7 days, then decrease down to 0.1 g/kg per day. If you don’t see results with this dose, try increasing the amount you’re taking and then re-evaluate after a few weeks.

Why is this the recommended dosing strategy?

Over a decade ago, researchers first documented what is known today as creatine loading, the most effective strategy for increasing muscle creatine stores by ingesting creatine monohydrate1.  They found that a five-gram dose of creatine significantly elevated blood creatine concentrations, peaking about one hour after ingestion and returning to baseline levels after 2–3 hours.

In order to keep creatine elevated throughout the day, a five-gram dosing regimen every two hours for eight hours was adopted.  Maintaining this creatine dosing protocol for at least two days resulted in significant increases in the total muscle creatine content (measured by muscle biopsies — ouch).

Since then, subsequent studies have confirmed what those researchers first established: this creatine dosing strategy is effective at increasing muscle creatine stores. However, it's not always necessary to dose this high or for a long period of time. Most of the creatine uptake occurs within the first two days, and muscle eventually becomes saturated with creatine in less than seven days at 20–25 grams per day.

You could also just eat more foods naturally rich in creatine, such as beef, salmon, herring, or pork. However, to get 5 grams of creatine each day would require about one kilogram of meat or fish (that’s about 2.2 pounds!). Unless you can stomach that much red meat or fish per day, the only way you're going to be able to get the recommended dose of creatine is with creatine monohydrate.

What type of creatine should women take?

As mentioned at the beginning of this article, creatine monohydrate is the most heavily researched and most popular of all the different types of creatine available on the market. Today, other types of creatine compete, but it seems that creatine monohydrate reigns supreme.

One of the most popular alternatives to creatine monohydrate is creatine ethyl ester, or CEE. Research conducted to date with this form of creatine has not found any benefit over creatine monohydrate in terms of muscle creatine content, body composition, strength, or power13-14. More importantly, the decades of data confirming the safety of creatine monohydrate do not exist for this or other forms of creatine, so buyer beware14.

Overall, if you want the benefits of creatine, I recommend you stick to creatine monohydrate. A micronized creatine monohydrate does exist on the market, and the only benefit of this is that it will be easier to mix in water and will not leave lumps. Take this version if that’s a quality you desire.

Is it safe to take creatine while pregnant?

Although the scientific work is minimal in this area, especially in humans, it does seem that creatine usage is safe and may actually pose some unique benefits for your baby. However, always consult with your doctor first, and make sure you feel comfortable with this decision before letting this information sway your decisions.

In a recent study from 2015, researchers looked at creatine supplementation on brain neuron differentiation in pregnant female rats16. Yes, this is a rat study, but the information is how we develop our research protocols for humans, so don’t tune out just yet.

Researchers found that creatine supplementation positively affected the morphological and electrophysiological development of brain neurons in offspring rats, increasing neuronal excitability. Translation: the brains of baby rats from female rats who took creatine were more active and possibly healthier.

Creatine may also benefit fetuses who are exposed to low oxygen levels in the womb or during birth (hypoxia). This is because creatine protects the brain against oxidative stress and stabilizes lipid membranes of the brain 17. It also maintains intracellular ATP and acid-base balance, and supports cerebral vasodilation.

Researchers also suspect that creatine can offer neuroprotective benefits to a fetus and accordingly may reduce the risk of adverse neurodevelopmental outcomes, such as cerebral palsy and associated impairments and disabilities arising from fetal brain injury18.

All these researchers conclude that scientific investigations eventually need to be conducted in humans first, before any of these hypotheses can be found to be true.

Should I take creatine?

With all this information, you can now make a reasonable decision to use creatine as part of your strength and fitness supplement strategy or not.

The data available to date shows that adequate creatine supplementation for durations longer than one month seems to have a beneficial effect on strength, body composition, and exercise performance in women.

Keep in mind that creatine can cause water retention, which can potentially interfere with blood pressure and other medications.

The Bottom Line:

  • Creatine monohydrate will help you train harder so that you lift more weight and build more muscle.
  • Creatine may or may not cause water retention. If you do experience water retention, give it time to normalize before you jump ship.
  • Take at least 0.1 grams creatine per kilogram body weight per day with carbohydrates to have the best results in muscle creatine content.
  • Creatine may be safe to take during pregnancy, but always consult with your physician first before taking our word for it. Same if you have high blood pressure or take other medications.

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About the author:  Cassandra Forsythe, PhD, RD

Cassandra Forsythe, PhD, RD, CSCS, CISSN is an Assistant Professor at Central Connecticut State University (CCSU). She is a mother, entrepreneur, health and fitness enthusiast, and the author of The Modern Woman’s Guide To Good Nutrition. Cass is also on the advisory boards for Women’s Health magazine, and You can learn more about Cass on her website.


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